Which doctors can prescribe MS meds?

[lusciousleaves]

I've got a new dilemma. We're having to choose between insurance plans that have changed and rates that have gone up considerably since last year. I talked with the HMO rep today, which has become the only affordable option left for us.

The neurologist I'm currently seeing is not part of the network. I'd also need to change GPs to someone unfamiliar with my health issues. Meds are covered by anyone that prescribes them, except for injectables, which must be prescribed by an network physician.

I can see the neurologist for cash for far less than paying for the PPO plans, but if he ends up prescribing an injectable med, it wouldn't be covered.

Could a GP prescribe this if recommended by a specialist as medically necessary?

We have to have our decision in by Friday on which insurance plan it is we are going to choose. All of my other specialists accept the HMO, and I really don't want to have to find another neurologist. There aren't many good ones in this area, I've already found out.

[22cyclist]

All MS medications must be prescribed by neurologists. This is under their scope of practice.

GPs cannot order those types of meds even if some demented old neurologist asked them to. It is not under their scope of practice. They don't know enough about them, their side effects etc. to be responsible for ordering and monitoring you for that.

When you get a new neurologist, and if you get diagnosed, you can get a prescription from them. They will arrange the set up through the pharmaceutical company and your meds will be shipped to you. You will be under nursing supervision through the pharmaceutical company, and supervision from your neurologist. The rest of your neurological medications can be prescribed by either doctor, depending on how your neurologist feels about it, and how your PCP feels about prescribing it.

Good luck in finding new docs!

Lisa
Moderation Team

[lusciousleaves]

Demented old neurologist? LOL Nice. I kind of figured a GP couldn't order it. We are just going to have to stick with what we have for another year. Maybe my situation will improve enough that I can get back to work. I sure hope so.

[lusciousleaves]

Can a general neurologist prescribe DMDs, or is this the domain of the more specialized MS doctors?

[AF PA]

Any PCM can prescribe MS meds

I don't post often but felt obligated...

I am a Physician Assistant and have prescribed MS meds myself. Any PCM that is comfortable with the medication has the ability to prescribe MS meds, other than Ty which requires enrollment in the Touch program. If you have a recommendation for med regimen from a neurologist that makes it much easier.

I recommend you develop a good relationship with your new PCM and ask them if they/or anyone in their practice is comfortable with prescribing. I keep my MS diagnosis private, however I consult with most of the MD's I work with on meds and will generally help with MS patient's care because it is known that I keep up on common MS practices/meds.

Good luck.

[MSer102]

No MS medicines don't have to be prescribed by a neurologist. I have heard of people having their MS medications prescribed by their GP's. I've heard of people having their glaucoma medications prescribed by their GP's even though they have no way to monitor the patient's glaucoma. And doctors violate black box warnings all the time because they have a license to prescribe a medicine even though they don't have the experience to manage it.

A medical license gives physicians a pretty broad range of abilities including prescribing medications. Any doctor with a license to practice can legally do pretty much anything that isn't malpractice. Except for controlled substances I've never heard of a medical doctor being unable to prescribe a medication. "Scope of practice" restrictions apply to other health care practitioners, but I've never heard of them applied to medical doctors.

A physician's scope of practice includes anything medical, which includes prescribing medications. Your GP can prescribe pretty much anything. Not being experienced enough to know if the medication is appropriate or not knowing how to manage the medication falls under malpractice laws, not scope of practice.

Specialists don't even have to be board certified to practice in their specialty. And a physician from any specialty can take a weekend seminar about doing laser skin surgery and practice on a tomato and then start doing laser surgery on patients on Monday - because they have a medical license and "some" training. So I don't know why there would be restrictions on what kinds of medicines a licensed doctor can prescribe.

If you have a question about it maybe you could call the public relations office of the medical board in your state? They would know.

I think where you might run into trouble is that your new HMO GP might not agree to take responsibility for and prescribe a medication they aren't familiar with, even if it was originally prescribed by a neurologist. And you can't know that until after you've already committed to the HMO.

I'm in an HMO because it's the only thing I can afford. Even though I've had to go through several really crappy neurologists, I've never had any trouble getting medications.

I'm wondering if you might do better with an HMO neurologist. A neurologist might be more willing than a GP to continue with a prescription written by another neurologist, even one out of network that he or she doesn't know.

HMO docs are familiar with people coming into the HMO after having seen other doctors who are out of network, and they're familiar with people who continue to see their other out of network doctors. There's no predicting what they will do about that though. But at least the neurologist should be familiar with MS medications and know how to manage them. Maybe or maybe not but they should be more familiar with MS medications than a GP.

My HMO has its own pharmacy. I have never, ever been in contact with any nurse or anyone else connected with the drug manufacturer or outside pharmacy. My injection training was done by a nurse at my medical center. She happened to have a video tape from the manufacturer about the medicine I was using which I borrowed and returned to her. Everything I got from the drug manufacturers came after I signed up with them, not because my HMO or medical center did anything to connect me with them.

I pick up all of my medications at the pharmacy at my medical center. None of my medicines have ever been shipped to me by an outside or specialty pharmacy.

So I think you should be ready for things to be different than what you might be used to now, even if somebody tells you differently. I think if you want to know where your specialty medicines are going to come from and how you are going to get them you should call the HMO.

If the HMO is all you can afford, then it's all you can afford. It might not be easy to navigate but there are ways of getting things done if you are flexible about the process.

[Marco]

I wouldn't be surprised if some of the drug manufacturers require a doctor to establish a relationship with them to prescribe their medications, but this is more of an administrative and not legal requirement. I am aware of non-neurologists prescribing MS medications. Even more prescribe complimentary medications that are off-label use to begin with. Of course, these are the exceptions and not the rule.

Are any of the oral medications on the HMO formulary? Aubagio, Tecfidera or Gilenya? If so, couldn't your private-pay neurologist prescribe one of the oral meds? Are there any neurologists on the plan that your doctor can refer you to for prescribing purposes? You could also contact the drug company directly and explain your situation as they might have a form of relief for you.

[lusciousleaves]

Thank you for the input, AF PA. We are going to have to stick it out with the lower coverage PPO for another year until all of this settles. Hopefully, most of the testing is over and we won't hit the out-of-pocket max with it again.

This will give me some time to find a new GP who takes the HMO and figure this out. In the meantime, I have a neuro that I can trust. Seeing as how that is my main health issue at the moment, it makes sense to stick with it for now.

There is simply too short of a time frame to make this decision before all of the testing is in, and the employer's policy changes were a complete surprise out-of-the-blue. If we only had another week to decide, it would have made a huge difference.

Blind leap of faith, either way.

[lusciousleaves]

Marco, all of the MS meds are obtained through what they call their "specialty formulary." Some policies cover the specialty formulary and some don't. Apparently, this is a brand new HMO policy with this company, because there isn't much information about it on their website, including whether or not this specialty pharmacy was a covered benefit. I have no way of getting that information, as the rep I contacted today couldn't even answer that question.

[lusciousleaves]

MSer, gosh, I just read your reply. I'd love to go with the HMO this year if we could. We could really use the financial break.

What happened was, we were with what they're now calling a "premium" PPO. All of the testing with this plan was covered 100% in network, and the out of pocket max was lower than the lower priced plan we had before, as were the deductibles.

We opted to pay upfront a higher premium to avoid getting hit in the backside if more testing were ordered. It turned out to be the right decision, but we're going backward financially regardless. The premium is too high along with all of the copays.

The employer dropped the company offering the PPO plans we've been using for nearly a decade, and is offering equivalent plans with another company. The lower priced PPO is now offered at the rate our current plan premium (too high premium, higher deductibles, higher out of pocket max). The plan equivalent to what we have now has jumped in price another $150/month.

IF I can get to feeling better and get myself back to work, we'll be okay with the lower coverage PPO. Even just a few hundred $$ a month would make a difference here of going backward or not with this.

Likewise, IF we can stop running from this specialist to the other for testing on every body part that malfunctions, that lower priced PPO might not soak us as excessively as it has in the past.

It's the medical merry-go-round that's the problem. Some real answers here would not only give me a known enemy to fight, but it would hopefully cut down on all of the crazy testing for everything under the sun.

The HMO would be the best choice for us financially. But medically, these changes couldn't have come at a worse time. It finally looks like we're getting to the bottom of this. If, in fact, I end up diagnosed in the near future and start on treatment, it would only be for a few weeks before having to switch to new docs. I can't see doing that. It makes me too uncomfortable.

[MSer102]

That reminds me of the old saying: Don't change horses in the middle of the stream. For the reasons you mentioned, it might be better to finish your "ride" with the same doctors.

I guess employers are looking for any way they can to keep their costs down under the new health care law, including dropping the insurance plans that cost them the most. My HMO still doesn't know what they're going to do with my plan. It looks like we'll have to wait another year to see how it all shakes out. Hopefully you'll have a diagnosis by then and will have a better idea of what to expect.

[lusciousleaves]

The exact same saying that's been coming to mind for me these last two weeks. I'd better heed the warning. Our running joke is, "We still have the credit cards!" And we've had to use them. The only thing that saved us this year is that my mom left us a little something when she passed away. Before that, our mortgage payment was bouncing our checking account every month. I might be able to make it last through next year. It just makes me so sad that this is what I have to spend it on. She saved our hides.

[22cyclist]

luciousleaves: I am talking about your injectables, and infusions. A PCP cannot order these, and will not order these. Your neurologist will, or their PA or NP will do it. It has more to do with training as MSer102 points out, and PCPs do not have the training to prescribe DMTs. Other MS medications, sure, like neurotin, tegretol, etc.

Best of luck

Lisa

[Kiki04]

I believe that legally the PCM can write the prescriptions, but one of our insurance rule is that they will only be covered if written by a neurologist. So yes the PCM could write the script, but the insurance may not pay for it.

Good luck in finding your new providers. It can be a real pain.

I'm sure the PCP's liability insurance would be thrilled to discover that the doctor prescribed a drug with potentially disastrous side effects when he/she has no training in the relevant field of medicine.

Just look at Michael Jacksons Doctor and the mess he is in.